1. Healthier Babies: A Regional Collaborative to Improve Birth Outcomes for Pregnant Women on Medicaid Richard J. Baron, MD, FACP President and CEO Healthier Babies, Healthier Futures, Inc National Disease Management Summit Baltimore, MD May 13, 2003

2. Maternity in Medicaid  High prevalence Medicaid population demographics Pregnancy as Medicaid qualifying event  Big percentage of overall hospital use in a Medicaid Plan (NCQA data) Total Discharges/1000 MM=8.35 Maternity Discharges/1000 MM=3.55 Meaning Maternity=42.5% ALL Hosp

3. Clinical and Financial Impact of LBW  LBW infants 40 times more likely to die in first 4 weeks of life  Average 1 st year of life costs for LBW infants: $93,800  Savings for LBW over VLBW infant: $59,700  Estimated savings per dollar invested in LBW prevention: $3 Source: NCQA Web Site

4. Medicaid Patients do worse  NY State Pooled Managed Care Data Total population: 6,977,275 25 Commercial Plans, 21 Medicaid Plans

5. Risk-Adjusted Low Birth Weight Population Rate Commercial v.s. Medicaid

6. Medicaid Patients do worse  Healthy People 2000 LBW Goal: 5%  Healthier Babies Medicaid LBW: 11.3%

7. What are the challenges to improving birth outcomes?  Some intrinsic to Medicaid Population turnover “Social issues”: housing, poverty, education Cultural barriers  Some “clinical” Absence of clear knowledge base on “what works” Significant co-morbidities (Substance Use, HIV, Mental Health...)

8. History and Background HBHF RWJF RFP: “Mending the Safety Net” HealthChoices: Pennsylvania’s Mandatory Medicaid Managed Care Program –Philadelphia and 4 surrounding counties 4-6 Potential Contractors 15,000 deliveries per year

9. Broad, simple concept: Agree on one standard prenatal clinical data collection tool for MMCOs –Replace a heterogeneous, overlapping approach Build a centralized database to receive data Link with DOH Birth Certificate Database Produce state-mandated HEDIS and other reports

10. Problems identified at RWJF/CHCS site visit: Long term funding Confidentiality –Administrative/legal –Control/appropriate use Ownership

11. UPEF Development Clinician in charge Commitment to a one page form Commitment to obtain only data that would or should be available to a clinician at each visit Commitment to capture relevant clinical and “social” risks Initial input broadly participatory, final execution very narrow Field tested

12. Barriers Competitiveness Resource constraints under HealthChoices Confidentiality Marketplace events Provider and Advocate concerns “Null hypothesis” for prenatal intervention

13. Governance New non-profit corporation: Healthier Babies, Inc Solved both ownership and control issues Three classes of Directors –Appointed Directors –Health Department Directors –At Large Directors Has itself created opportunity for collaborative action

14. Critical Success Factors Defined universe of MMCOs Defined universe of providers Clearly (sort of) defined clinical data set Leadership

15. Results We exist, Board meets every other month We have Bylaws, contracts, money Over 90% of prenatal encounters are reported –5 counties, 225 sites, 800 providers Database actually works –Case management –Reporting

16. HEALTHIER BABIES: UPEF ENTRIES: 1999-2001

19. Figure 1. Weight Of Selected Risk Factors Based On Their Strength Of Predicting Poor Birth Outcome (2000/2001 Births)

20. 66.4% 68.5% 23.6% 21.3% 10.0%10.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% N=9838 Health Choices N=6624 Top 24 Providers 0 to 9.49 = Low9.5 to 25.49 = Medium25.5 to 120 = High Figure 3. Weighted Risk Score

21. 66.4% 78.5% 54.8% 23.6% 16.0% 32.7% 10.0% 5.5% 12.5% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% N=9838 Health Choices Population N=163 Provider P N=104 Provider S 25.5 and higher = High 9-5 - 25.49 = Medium 0-9.49 = Low Figure 4: Weighted Risk Score for 2 Selected Individual Providers Compared to Health Choices Population

24. Health Choices PopulationProvider S

25. Figure 6. Provider Variation in Birth Outcome By Risk Group (Largest 30 Providers) High Risk Mean = 19.9

26. Healthier Babies, Healthier Futures N=13,467 N=4,165 N=9,302 N=13,932 N=4,096 N=9,836 N=13,618 N=5,344 N=8,274

27. Healthier Babies, Healthier Futures N=5,344 N=4,096 N=4,165 N=8,274 N=9,836 N=9,302 N=13,618 N=13,932 N=13,467

28. Healthier Babies, Healthier Futures

29. Key Constituents Healthier Babies, Healthier Futures, Inc. AmeriChoice of Pennsylvania Health Partners of Philadelphia Keystone-Mercy Health Plan Community Behavioral Health System Philadelphia Health Management Corp Philadelphia Department of Public Health Department of Public Welfare, Commonwealth of Pennsylvania